Ischemic stroke: symptoms, consequences, treatment, prognosis

What it is? Ischemic stroke - this is the beginning of the death of the brain region, which occurred due to a violation of the inflow of blood to it.

This type of cerebral circulation disorders accounts for 85% of cases.

The disease develops due to a huge number of causes, most of which occur in the pathology of the heart.

Ischemic stroke has quite specific signs that allow the doctor to suspect a disease of any specialty. If treatment is started in the first hour after the development of symptoms, the chances of a favorable outcome and the absence of disability increase severalfold.

Causes of Ischemic Stroke

Why is ischemic stroke occurs, and what is it? Ischemia of the brain region occurs if an obstacle takes up 75% or more of the diameter of the vessel on the way of blood flow through some of the arteries feeding the brain.

It can be:

1. 1) Embolus, that is, a thrombus that has flown off;usually this is due to an arrhythmia fault or due to heart valve flaws, myocardial infarction;
   
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2. 2) Atherothrombotic plaque is the result of superimposing the lipid complex on the vessel walls( in the case when cholesterol and low-density lipoproteins predominate in the blood above high-density lipoproteins), which has either grown so large that it blocked the artery lumen or cracked, and eventuallya blood clot was applied;
   
3. 3) Thrombus in artery( usually small caliber);
   
4. 4) Vascular diseases, which result in increased growth of their muscular membrane, which narrows their lumen.

In some cases, the cause of ischemic stroke remains unclear. There are several risk factors for the development of this disease, and the more they have one person, the more he has a chance to get sick. These are the following diseases and conditions:

• rheumatic heart valve disease;
  
• ischemic heart disease;
  
• increased blood viscosity;
  
• pacemaker;
  
• defibrillation, which increases the risk of separation of thrombotic masses present in the heart and blood vessels;
  
• heart failure;
  
• arrhythmia, especially permanent form of atrial fibrillation;
  
• diabetes, especially when combined with obesity;
  
• smoking, alcohol intake;
  
• atherosclerosis or elevated blood levels of low and very low density lipoproteins and cholesterol;
  
• use of birth control pills;
  
• pathology of the blood coagulation system;
  
• migraine;
  
• is a sedentary lifestyle;
  
• of blood disease;
  
• hypertension;
  
• of inflammation of vessels in case of lupus, rheumatism, infectious diseases( syphilis, AIDS);
  
• lung diseases, which significantly increases the viscosity of the blood( bronchitis, emphysema, bronchial asthma).

Symptoms of ischemic stroke

Initiation of ischemic stroke is acute, usually after a night's sleep, but the symptoms can appear at any time of the day.

The first usually develop:

• loss of consciousness, sometimes accompanied by convulsions with respiratory failure;
  
• disorientation in space - usually after an unconscious episode;
  
• headache;
  
• nausea, rarely vomiting.

After a person regains consciousness, he has focal neurological symptoms, which depend on which artery of which vascular system is affected.

There are two large vascular networks in the brain:

1. 1) Basin of the carotid artery, which includes 3 arteries - anterior, middle and posterior - on each side;sections of their blood supply intersect, which to some extent "insures" against the development of acute vascular insufficiency;
   
2. 2) A vertebrobasilar basin that provides blood to those brain structures in which vital centers are located: respiratory, vasomotor and others.

Supplies this structure to the blood: the cerebellum, the medulla oblongata, and the initial section of the spinal cord.

According to the symptomatology observed in the patient, the neurologist can accurately name a large artery, the branch of which has suffered. Below are just the main symptoms, characteristic of the defeat of some of the pool.

Thus, with stroke in the basin of the carotid artery there are such symptoms:

1) Violation of movements in the arm and leg( paralysis or paresis) that develop on the side opposite the focus of ischemia( on the way to the brain, the nerve bundles coming from the extremities,cross over so that in the left hemisphere there are impulses from the right arm and leg, and vice versa);

2) Speech disorder( aphasia) in the form:

• impossibility of its reproduction( such people can pronounce only one syllable at once, although they want to explain something; they hear and understand the spoken speech, they suffer from the inability to express their thoughts);
  
• misunderstanding of speech;
  
• reproduction of separate, unrelated words in sentences that do not answer the question asked;
  
• lack of ability to name objects, looking at their appearance;
  
• violation of written speech;

Such disorders occur if the stroke develops in the dominant( for right-handed people this is left) hemisphere :

• memory deficiency;
  
• the skew of the face on the side of the hearth;
  
• the inability to fully open an eye;
  
• blindness in one eye;
  
• at the request to stick out his tongue will be seen his deviation in any of the parties.

If the stroke developed in the vertebrobasilar basin , the following symptoms will develop:

• impaired coordination;
  
• dizziness;
  
• it is difficult to pronounce individual letters or syllables, understanding of speech is not changed;
  
• a quiet, indistinct speech;
  
• on the opposite side decreases the normal volume of movements in the limbs;
  
• vision impairment;
  
• difficulty swallowing, choking if swallowed food or water.

With , the localization of ischemic stroke in the trunk of the shows life-threatening abnormalities: the

• rapidly develops a paralysis of all four limbs;
  
• is very much lowering blood pressure;
  
• is oppressed by consciousness( it is difficult to awaken a person);
  
• develop abnormalities in the rhythm and depth of breathing;
  
• urinary and fecal incontinence.

If the stroke of is localized in the cerebellum , then there will be such signs:

• headache;
  
• dizziness;
  
• inability to stand or walk - there is a tendency for the body to fall in some direction;
  
• human movements become inconsistent;
  
• eyeballs spontaneously and quickly move horizontally or vertically.

Stroke is also dangerous because ischemia in the brain leads to the development of its edema, and it will be local or generalized, it can not be predicted. In severe cases, edema of the brain and the cerebellum can cause the brain to shift into the cranial cavity and be injured in some of its bone orifices.

This is called a dislocation of brain structures and manifests itself:

• at the beginning - severe headache, nausea and vomiting;then there will be other symptoms;
  
• increase in the depth of impaired consciousness;
  
• by changing the diameter of both or one pupil;
  
• is a violation of breathing( its rhythm becomes wrong, while it can be both superficial and deep).

See also, signs of cerebral stroke.

Treatment of ischemic stroke

An ischemic stroke can be suspected by a doctor of any specialty, but the diagnosis can be confirmed only with:

1. 1) Computer tomography: this research method identifies ischemia at its earliest stage, especially carried out with contrast;
   
2. 2) Magnetic resonance imaging: in terms of informativeness this method is not inferior, but in something even better than the first;
   
3. 3) Pngiography is an x-ray method of examination using a contrast agent introduced into blood vessels;
   
4. 4) If there is no possibility to carry out these studies, a lumbar puncture is performed. Due to the absence of changes in the form of the presence of blood or cells that indicate inflammation, the diagnosis is "Ischemic stroke".

In addition, for treatment it will be important to evaluate the indices of such patient studies:

• of a general blood test;
  
• lipidograms( determination of fat fractions, including cholesterol, and their concentration in the blood);
  
• coagulogram - blood coagulation analysis;
  
• determinations in blood glucose concentrations.

If the diagnosis was made in the first hour of the development of symptoms, then the doctors of the intensive care units who work in hospitals of the neurological profile have the opportunity to prescribe thrombolytic therapy.


For this purpose, drugs "Aktelize", "Alteplase" and some others are used. The next stage of therapy will be the appointment of drugs-neuroprotectors. In an acute stage, "Somazina"( "Ceraxon", "Neuroxone") and "Cerebrolysin" are called to help the patient.

Drugs that improve the permeability of blood vessels are also prescribed: Trental, Clopidogrel, and antioxidants: Mexidol, Actovegin, Mildronate. The above therapy is impossible without organoprotective - a person needs to provide:

• a normal level of blood pressure: drugs are used to reduce or increase it;
  
• sufficient level of oxygen in the blood: using an oxygen mask or transfer to a hardware breath;
  
• adequate blood viscosity;
  
• rhythmic cardiac activity,
  
• reduction of cerebral edema,
  
• physiological blood glucose level.

After the end of the acute period of a stroke, it is very important to carry out rehabilitation measures, which is not only about taking medication, but also in exercise therapy, massage, exercises with a speech therapist and a psychologist, physiotherapy procedures.

Read also, symptoms of hemorrhagic stroke.

Prognosis for ischemic stroke

Only the attending physician can determine the prognosis for life in a particular person. It takes into account various factors:

• localization of the focus of ischemia;
  
• volume of the lesion;
  
• time of onset and character of therapy;
  
• of the patient's age;
  
• chronic diseases.

Only people who have undergone lacunar stroke( thrombus localized in a shallow vessel) can fully recover( under condition of adequate rehabilitation).Mortality from a larger stroke is 15-25%, and most of the lives are carried out exactly the first month of the disease( especially the first 10 days).

Consequences of an Ischemic Stroke

All movements and sensations caused by a stroke can completely regress. Also a person can stay with 1-3 groups of disability.

Complications include:

• cerebral edema;
  
• congestive pneumonia;Pressure sores;
  
• sepsis;
  
• heart failure;
  
• ingress of thromboembol into the pulmonary artery system.

Prevention

To prevent the development of stroke, it is important to monitor and adjust with medical assistance such blood indicators:

1. 1) The content of cholesterol and low-density lipoproteins in the blood. When they are increased, a diet with a very small number of animal fats is made, special preparations are taken, the correcting levels of these fatty fractions in the blood. See how to lower cholesterol in the blood.
   
2. 2) Viscosity of blood. When it is increased, preparations like "Aspirin" or "Clopidogrel" are taken, the drinking regime of a person is normalized.
   
3. 3) Blood coagulation system. If the blood tends to over-clot quickly, "Warfarin" or "Clexane" preparations are prescribed.
   
4. 4) The level of glucose. Reduce blood sugar or with the help of special pills, or with the introduction of insulin.

Blood pressure is also monitored( it should not be high), with the help of ultrasound, head and neck vessels are inspected every year, rheumatic heart diseases are treated.

It is also important for prevention to lead a mobile lifestyle, to eat right.

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